Provision of Antimicrobial Stewardship Support to Coastal, Rural, and Remote Hospitals

ANTIMICROBIAL STEWARDSHIP

Provision of Antimicrobial Stewardship Support to Coastal

Rural and Remote Hospitals

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Tim T.Y. Lau, PharmD, FCSHP

Pharmacy Lead, ASPIRES, VCH

Clinical Supervisor & Infectious Diseases/Antimicrobial Stewardship

Pharmacist, VGH

Daljit Ghag, PharmD,

Antimicrobial Stewardship Pharmacist, ASPIRES, VCH, VGH

Clinical Instructor, Faculty of Pharmaceutical

Sciences, UBC

On behalf of the ASPIRES Team: Dr. Jennifer Grant, Salomeh Shajari, Felicia Laing

AntimicrobialStewardshipProgrammeInnovationResearchEducationSafety

Martin Emig, BSc(Pharm)

Pharmacy Coordinator, PRGH

ASPIRES, VCH

Conflicts of Interest

• None to declare

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Questions?

1. What is antimicrobial stewardship?

2. Why do we need stewardship support at Coastal rural/remote sites?

3. How are we collaborating with rural/remote sites?

4. How are we doing at rural/remote sites?

5. What clinical resources are available for stewardship?

6. What are challenges with providing support for rural/remote sites?

7. What are lessons learnt?

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1. What is antimicrobial

stewardship?

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Aim Drivers Initiatives

• Improve patient outcomes

• Optimize antibiotic therapy

• Reduce selection for antibiotic resistance

• Reduce antibiotic adverse events

Academic

Detailing and

Interventions

Education and

Clinical Tools

Systems

Improvement

Evaluation and

Measurement

• New Rapid Diagnostic Technologies through Medical Microbiology

• Sunset Patient Screening Reports

• Sunset CDI Electronic reporting and intervention databases

• Audit and Feedback

o Broad-Spectrum

o IV to PO

o Antifungals

• Anti-Infective Comparison Card

• Clinical Practice Guidelines: CAP, CDI, Surgical Prophylaxis, UTI, VAP

• Common Infections Card

• PPOs: CAP, Sepsis, SSTI, UTI

• Prescriber Engagement

• Restricted Antibiotics PPO

• Antibiotic Utilization

• Anti-Infective Costs

• CDI Pharmacy Follow-Up

• Databases for Audit and Feedback Interventions

• Interventions and Compliance

Antimicrobial Stewardship

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2. Why do we need

stewardship support at Coastal

rural and remote sites?

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2. Why do we need stewardship support

at Coastal rural and remote sites?

• Antimicrobial stewardship

– Accreditation Canada

• Required Organizational Practice

– Ministry of Health

• Clinical Care Management initiative

• Antimicrobial Stewardship Programme

(ASPIRES), Quality & Patient Safety at VCH

– Promote good antimicrobial prescribing

– Provide resource

– Improve patient outcomes and safety

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3. How are we collaborating

with rural/remote sites?

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3. How are we collaborating with

rural/remote sites?

• January 2015

– Martin Emig recruited as ASPIRES liaison

– Identified key physician, pharmacy, nursing, and

infection control stakeholders

• February 2015

– Site visits to establish local working groups; Bella

Coola already had stewardship group in place

– Environmental scan for stewardship activities

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3. How are we collaborating with

rural/remote sites?

• March 2015

– Established baseline antibiotic consumption data at

sites to track usage over time

• April 2015

– Provided site-specific clinical guidelines/resource

support

• November 2015

– Videoconference educational sessions and updates

of stewardship initiatives at sites

– Planned quarterly sessions

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4. How are we doing at

rural/remote sites?

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Site Bella Bella Bella Coola

Powell River Sechelt Squamish

Medical Director

Dr. Lauri-Ann Shearer Dr. Erika Cheng

Dr. Pierre Duplessis

Dr. Sara Wadge Dr. Richard Cudmore

Physician Dr. Lauri-Ann Shearer Dr. Erika

Cheng

Dr. Blake

Hoffert

Dr. Sara Wadge

(Dr. Jesse Morantz)

Dr. Jim (James)

Jamieson

Pharmacist Mohamad Naser, (locums)

Donna Ratcliffe

Martin Emig Ann Beardsell Dr. Tony Howarth

Nurse Genvieve Latrace;

Susan Chatelier

Susan

Koury

Nova Cleghorn Monique Roy-

Michaeli

Veronica Fincham

4. How are we doing at rural/remote

sites?

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Carbapenems: Imipenem/Meropenem

IV with Oral Bio-equivalents (eligible for oral step-down): Clindamycin, Ciprofloxacin, Cotrimoxazole, Metronidazole,

Moxifloxacin (No Linezolid use at any of the 5 sites).=

Broad-Spectrum or Restricted: Vancomycin, Ceftazidime, Piperacillin-tazobactam (No Daptomycin use at any of the 5 sites)

SGH: TBD

Data based on purchasing records

4. How are we doing at rural/remote

sites? Target Antibiotics Utilization at Rural/Remote Sites

FY 2014/15

• Antimicrobial Stewardship Survey

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4. How are we doing at rural/remote

sites?

Bella Bella

• ASP needs:

1. Customize local

guidelines/pocket cards (SSTI

and MRSA)

2. Develop common infections

PPO

3. Provide ID/Med

Micro/Pharmacy contact

resource

Bella Coola

• ASP needs:

1. Customize local guidelines/

resources (antibiogram, UTI)

2. Develop criteria for

piperacillin-tazobactam audit

3. Provide educational sessions

(video and teleconferencing)

4. How are we doing at rural/remote

sites?

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Powell River

ASP needs:

1. Customize local guidelines/

pocket cards (UTI algorithm)

2. Develop criteria for

piperacillin-tazobactam use

3. Provide prescriber education

Sechelt

• ASP needs:

1. Develop criteria for

ertapenem use

2. Customize common

infections card for site

3. Provide education on IV to

PO stepdown criteria

4. How are we doing at rural/remote

sites?

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4. How are we doing at rural/remote

sites?

Squamish

• ASP needs:

1. Customize local

guidelines/pocket cards

(common infections)

2. Develop criteria for ertapenem

use

3. Provide ID/Med Micro contact

resource

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5. What clinical resources are available for stewardship?

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5. What clinical resources are available for stewardship?

VCH intranet site

5. What clinical resources are available for stewardship?

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6. What are challenges with providing support for

rural/remote sites?

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6. What are challenges with providing support for rural/remote sites?

1. Limited resources and manpower

• Regionally

• Locally

2. Communication gap

3. Identity

4. Data source

5. Maintenance of momentum

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7. What are lessons learnt?

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7. What are lessons learnt?

1. Collaborative effort

2. Identification and engagement of key

stakeholders

3. Respect cultural and practice differences

4. Customize resource support

5. Encourage ownership

“Improve patient care and safety…”

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Questions?

• Dr. Jennifer Grant Medical Director,

ASPIRES

Email: [email protected]

• Dr. Tim Lau

Pharmacy Lead, ASPIRES

Email: [email protected]

• Dr. Daljit Ghag Antimicrobial Stewardship Pharmacist,

ASPIRES

Email: [email protected]

• Martin Emig

Coastal Rural Pharmacy Liaison, ASPIRES

Email: [email protected]

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